PMMA Removal Phalloplasty

Dr. Solomon, Forum Member "Chrisresearch" asks: "Hi Dr. Solomon, I have been reading your posts and researching revision. Regarding PMMA removal, can it be done if there is not much PMMA?"

PMMA causes an inflammatory reaction as it integrates with your tissues. Often, the amount of PMMA is relatively small compared with the reaction that it creates. If these areas can be readily identified on physical examination, then its removal is fairly straightforward, regardless of the amount of PMMA injected.

Dr. Solomon, The Moderation Team would also like to add the last question: How do you gauge whether removal or revision of a penis filler is "safe" or "advisable." How does this assessment apply to all the cosmetic filler varieties (from PMMA to hyaluronic acid (HA) to silicone oil)?

All surgical procedures have risks. The question of safety relates to several issues. First, does the benefit of the procedure outweigh the risk? If, by removing the foreign material, a more normal contour can be restored with minimal risk to the patient, then the benefit outweighs the risk. This issue is of more concern in patients with pain in their penis or migration or erosion of the material through the skin. Second, it is important that patients understand the risks of the procedure. Injection of materials in the penis varies widely. I have seen patients with injections that are placed deep in the penis as well as superficial. Removal of these injections includes not only the material, but the body’s reaction to the material. For things like hyaluronic acid, this reaction is often minimal. For silicone, the reaction can be large, as it can for PMMA. This is due to the properties of these various materials. So the surgeon must account for the location of the injection, the reaction it has caused and the initial material injected. With all injections, there is an issue of loss of blood flow to the skin superficial to the injection. The skin of the penis is thin and its blood supply is often adversely affected by these various injections (and other procedures). Therefore, removal of material is not only about the material and the reaction, but attempting to preserve blood flow to the overlying skin to avoid loss of skin that could require additional surgery to repair the loss.

Dr. Solomon, you have two locations, one on the East Coast (Philadelphia, PA) and the other on the West Coast (Los Angeles, CA). Do you have a set schedule between the Clinics or is one a primary location with the other being on an as-needed-by-appointment basis?

Typically, I spend 25% of my time in Los Angeles and 75% in Philadelphia. With the onset of the Covid-19 pandemic, I have limited my travel to Los Angeles. This is because the disease is fairly well controlled in Philadelphia. Were I to go to Los Angeles at the present time, I would need to be quarantined for 14 days upon my return, which is disruptive to my schedule in Philadelphia. Therefore, until that restriction is lifted, I will need to limit my time to Philadelphia only. I do have a waiting list for surgery for patients in Los Angeles, so when I return, I will be operating and seeing patients in consultation. Until that time, I have been using telemedicine to provide secure, encrypted video meetings with patients who cannot travel to Philadelphia. These appointments are arranged by calling my office.

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